Endotracheal Tube Cuff Pressure Measurement Techniques: Safety and Reliability: A Randomized Comparative Study (original) (raw)
Related papers
2022
Objective This study aimed to qualitatively assess and compare some techniques involved in cuff inflation and its corresponding pressure estimations as well as associated complications among patient s undergoing general anaesthesia with intubation for cesarean section at the obstetric unit of the Tamale Teaching Hospital. Results Finger palpation of the pilot balloon, predetermined volume of air, and a pressure gauge were used to measure endotracheal tube cuff pressure after intubation . Associated side effects were determined after 24 hours of endotracheal tube extubation. Data for 384 patients were included in the analysis. Cuff pressure measured among patients varied from < 20 -30 cmH 2 O for the standard manometer group, 20 to 50 cmH 2 O for the predetermined volume of air group and < 20 to < 50 cmH 2 O for the finger palpation group. Side effects were recorded in 2.3 % of patients from the standard manometer group, 53.2 % from the predetermined volume of air group and ...
Anesthesiology Research and Practice, 2017
Background Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal technique for establishing and maintaining safe cuff pressures (20–30 cmH2O) is the cuff pressure manometer, but this is not widely available, especially in resource-limited settings where its use is limited by cost of acquisition and maintenance. Therefore, anesthesia providers commonly rely on subjective methods to estimate safe endotracheal cuff pressure. This study set out to determine the efficacy of the loss of resistance syringe method at estimating endotracheal cuff pressures. Methods This was a randomized clinical trial. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. Study participants were randomized to have their endotracheal cuff pressures estimated by either loss of resistance syringe or pilot balloon palpation. The pressures measured were recorded. Results One hundred seventy-...
Estimation of Endotracheal Tube Cuff Pressure in a Large Teaching Hospital in Ghana
Open Journal of Anesthesiology, 2015
Background: Maintenance of optimal Endotracheal Tube cuff Pressure (ETTcP) in anaesthetic practice reduces cuff pressure complications. Aneroid manometers for measurement of ETTcP are not widely available in Ghana, hence anaesthesia providers estimate ETTcP according to their experience. The study assessed ETTcP obtained from estimation techniques between anaesthesia providers at Korle-Bu Teaching Hospital (KBTH). It also evaluated the Volume of Air Required (VAR) to obtain an acceptable cuff inflation pressure for sizes 7.0 and 8.0 mm adult endotracheal tubes used at the hospital, and the effect of patient's age, weight and height on this volume. Methods: Eighty-one patients who underwent general anaesthesia were recruited. ETTcP was measured using an aneroid manometer via a three-way tap. After full cuff deflation, the cuff was refilled with air until an ETTcP of 20 cm H2O was obtained. Independent t-test was used to measure the statistical variations in the ETTcP using estimation techniques in relation to recommended levels as well as the significant difference of mean VAR to obtain a cuff pressure of 20 cm H 2 O. Grouped t-test was used to determine significant differences in ETTcP between anaesthesia providers using estimation techniques. Results: Mean ETTcP obtained from estimation techniques was (61.87, 73.79) cm H 2 O. The mean ETTcP measured for Physician and Nurse Anaesthetists were 65.36 cm H 2 0 and 69.52 cm H 2 O respectively. The mean VAR to achieve an ETTcP of 20 cm H 2 O for endotracheal tube sizes 7.0 mm and 8.0 mm were 3.90 ± 1.13 mls and 4.55 ± 0.95 mls respectively. Age and E. O. Darkwa et al. 234 weight significantly influenced the VAR to achieve a cuff pressure of 20 cm H 2 O, however, height did not. Conclusions: This study demonstrated that cuff pressures obtained by estimation techniques were generally higher than the recommended average with no significant difference between anaesthesia providers. However, in the absence of an aneroid manometer, ETTcP of tube sizes 7.0 mm and 8.0 mm can be safely approximated to the recommended levels with predetermined inflation volumes.
Asian Journal of Pharmaceutical and Clinical Research Journal, 2022
The purpose of this study is to compare routinely used cuff insufflation techniques to finger-pressure and minimal leak procedures for achieving safe endotracheal tube (ETT) intracuff pressures in patients undergoing endotracheal intubation. Methods: It is a prospective observational study conducted in patients undergoing elective surgical procedures under general anaesthesia at GITAM Institute of Medical Sciences and Research, Visakhapatnam from January 2019 to June 2020. In Group FP, which includes 50 patients, the ETT cuff (ETTc) was inflated by palpating the pilot balloon between the index finger and thumb until it became taut. When this point was reached, the syringe was detached from the pilot balloon, and a cuff manometer was attached. The pressure reading on the cuff manometer is noted. In Group ML, which includes 50 patients, the ETTc was inflated fully, and then the air was withdrawn slowly from the cuff with auscultation over the trachea until a small leak was heard. When the point was reached, the syringe was detached, and a cuff manometer was attached; pressure readings were noted. Results: Mean inflation cuff pressure in the FP group was 45.40±21.74 cm H 2 O and in the ML group was 28.68±8.35 cm H 2 O. In Group FP, out of 50 patients, cuff pressure in 14 (28%) patients was in the normal range; in 32 (64%) patients, the cuff was over inflated, and in 4 patients (8%) cuff was under inflated. In the group ML, 24 (48%) patients have cuff pressure within the normal range; in 18 (36%) patients, the cuff has been over inflated, and 8 (16%) patients have low cuff pressures. Cuff pressure adjustment was required in 36 patients (72%) in the FP group, whereas 26 patients (52%) in the ML group. ML group has a low incidence of postoperative complications, i.e., 10%, compared to the FP group, i.e., 18%. A positive correlation was seen between the measured cuff pressure and body mass index, Volume of air insufflated. Conclusion: The main conclusion is to realize the need to use manometers or better-automated controllers during routine anaesthetic procedures.
Clinical Practice, 2018
Manual inflation of tracheal tube cuff after intubation is necessary to provide a safe airway in intubated patients. An increase or decrease in the pressure of cuff balloon leads to serious complications such as mucosal necrosis and micro aspiration. The aim of the study was to compare the endotracheal tube cuff pressure measurements before and after selected nursing care in emergency patients underwent pilot balloon palpation during cuff inflation. Methods: A prospective cross-sectional design was utilized in the emergency department at Al Manial University Hospital upon a convenient sample of 100 mechanically ventilated patients from April 2016 to June 2017. Demographic and medical data were collected. Later, the endotracheal cuff pressure was checked with manometer before and 15 minutes after each nursing intervention and data were analyzed using SPSS software version 20. Results: The majority of the studied sample was male with mean age 47.09 ± 15. Significant differences were detected regarding Endotracheal suctioning (t=16.99, p=0.000), Changing body position (t=2.76, p=0.026) and sedating patients (t=3.951, P ≤ 0.0001). As changing patients' body position to lateral sides, performing endotracheal and applying sedation caused a significant decrease in cuff pressure 15 minutes after. Conclusion: ETT cuff pressure was affected significantly with medical and nursing procedures and the pilot balloon palpation volume method was not suitable to estimate cuff pressure during intubation and the cuff pressure must be monitored and controlled by the manometers.
Endotracheal tube cuff pressure monitoring: a review of the evidence
Journal of perioperative practice, 2011
Tracheal intubation constitutes a routine part of anaesthetic practice both in the operating theatre as well as in the care of critically ill patients. The procedure is estimated to be performed 13-20 million times annually in the United States alone. There has been a recent renewal of interest in the morbidity associated with endotracheal tube cuff overinflation, particularly regarding the rationale and requirement for endotracheal tube cuff monitoring intra-operatively.
South African Medical Journal, 2013
Tracheal stenosis is a potentially life-threatening complication that occurs as a result of damage to the endotracheal mucosa. Healing by granulation and re-epithelialisation causes cicatricial stenosis. [1,2] The stenosis may present weeks to months after intubation, often as an airway emergency, and is difficult and costly to treat. The incidence of post-intubation tracheal stenosis in intensive care patients is as high as 20% in some centres. [2] Endotracheal intubation is associated with varying degrees of tracheal injury. Autopsy studies have shown that maximal damage always occurs at the site of the cuff. [1] An over-pressurised endotracheal cuff impairs mucosal blood flow, causing ischaemia. [3] The recommendation arising out of this study was that cuff inflation pressure should not exceed 30 cmH 2 O. Early pathological changes are superficial tracheitis and fibrin deposits to shallow ulcerations overlying the anterior portion of the cartilaginous rings. The size and extent of the ulcers increase with time, leading to exposure of the cartilaginous rings. Softening, splitting and fragmentation of the cartilage follow at a later stage. [1] Many studies have shown that digital balloon palpation corresponds poorly with the actual measured endotracheal cuff pressure. [4-11] Despite this evidence, endotracheal cuff pressure manometers are not readily available in the theatre complex at Groote Schuur Hospital (GSH), Cape Town, South Africa (SA), and there are no manometers available in the trauma and emergency departments. Previous studies have shown unacceptably high cuff pressures in the prehospital setting and in emergency departments. [9,12,13] Considering the high rates of trauma in SA, it is important to prevent iatrogenic complications in these patients. To our knowledge, no studies have measured endotracheal cuff pressures in trauma or emergency patients in SA. The purpose of this study was to evaluate cuff pressures in the GSH trauma centre and theatre complex and to assess whether objective monitoring of cuff pressures with manometers is warranted. Secondary outcomes were whether the tube make or size and the place of intubation affected cuff pressure. Method An audit was conducted over a 4-month period at GSH. The audit consisted of 91 intubated patients in the trauma centre and 100 intubated patients in the theatre complex. They were randomly selected and their cuff pressures were measured by a single investigator to decrease inter-user variability. A minimum sample size of 16 patients per group was calculated to achieve 91% power to detect a difference of 30.0 between the null hypothesis (that both group means are 55.0) and the alternative hypothesis (that the mean of group 2 is 25.0), with known group standard deviations of 33.0 and 15.0 and with a significance level (alpha) of 0.05000, using a two-sided Mann-Whitney test assuming that the actual distribution is uniform. We used a larger sample size because we wanted to perform subgroup analyses. All data collected were recorded on a standardised datasheet and transcribed to an electronic database for analysis. Cuff pressures were measured using a Mallinckrodt cuff pressure gauge, for which the Endotracheal tube cuff pressures-the worrying reality: A comparative audit of intra-operative versus emergency intubations
Journal of Clinical Monitoring and Computing, 2018
The pilot balloon palpation (or 'finger-pressure') method is still widely used to assess the endotracheal tube cuff inflation, despite consistent evidence of its poor sensitivity in recognizing cuff overinflation. It was recently speculated that this may be related to the lower wall tension (due to the smaller radius) of the pilot balloon as compared with the cuff, according to Laplace's law. To verify this hypothesis and, secondarily, to assess whether the use of a 'large' pilot balloon (identical to the cuff) increases the reliability of this technique, 62 anesthetists (41 experienced anesthesiologists and 21 residents) were asked to estimate the pressure of a cuff inflated to 88 mmHg into a simulated trachea by feeling both a usual and a modified 'large' pilot balloon. A similar test was repeated at 40 mmHg. After palpation of the usual pilot balloon, only 35% of participants (49% of experienced anesthesiologists and 10% of residents) recognized considerable overinflation (88 mmHg), as compared with 87% of participants (95% of experienced anesthesiologists and 71% of residents) after palpation of the 'large' pilot balloon. Moreover, 89% of participants (85% of experienced anesthesiologists and 95% of residents) believed that pressure was higher in the 'large' balloon than in the normal one. However, only 32% of participants (51% of experienced anesthesiologists and none of residents) recognized slight overinflation (40 mmHg) after feeling the 'large' balloon. The pilot balloon size affects the sensitivity of the 'finger-pressure' technique, but it remains poorly reliable with a larger pilot balloon.
Anaesthesia and Intensive Care, 2019
Correct intracuff pressure of endotracheal tubes and supraglottic airway devices is required to avoid complications such as sore throat, dysphagia and dysphonia, while maintaining an adequate airway seal. However, intracuff pressure monitoring of airway devices during general anaesthesia may not receive the attention it deserves. The aim of this survey was to investigate the current practice regarding intraoperative cuff pressure monitoring in hospitals across Australia and New Zealand. An online ten-question survey was disseminated by the Australian and New Zealand College of Anaesthetists Clinical Trials Network to a randomised selection of 1000 Australian and New Zealand College of Anaesthetists Fellows working in private and public hospitals of varying sizes. There were 305 respondents in total, but not all respondents answered all questions. In total, 67 of 304 respondents (22.0%) did not have access to a cuff pressure manometer at their main site of work, and of these, 30 (9.9...
Signa Vitae - A Journal In Intensive Care And Emergency Medicine
Introduction. Endotracheal tube (ETT) cuff pressure is not usually measured by manometer and the providers rely on their estimation of cuff pressure by palpating the pilot balloon. In this study, we evaluated the pressure of ETT cuffs inserted by emergency physicians or anesthesiologists, and assessed the accuracy of manual pressure testing in different settings using a standard manometer. Methods. In this cross sectional study, the cuff pressure of 100 patients in emergency department (ED) and intensive care units (ICU) of two university hospitals was evaluated by using a sensitive and accurate analog standard manometer after insertion of the ETT and checking the pilot balloon by the provider. All measurements were performed by a person who was blinded to the study purpose and an ideal pressure range of 20 to 30 cmH 2 O was used for analysis. Results. Emergency physicians (n=58) and anesthesiologists (n=42) performed the intubations. The mean measured cuff pressure in our study was 69.2±29.8 cmH 2 O (range: 10-120 cmH 2 O) which was significantly different from the recommended standard value of 25 cmH 2 O (P<0.0001, one-sample t-test). No difference was found between anesthesiologists and emergency physicians in cuff inflation pressures (Anesthesiologists = 71.1 ± 25.7; Emergency physicians = 67.9±32.6). Conclusion. Estimation of cuff pressure using palpation techniques is not accurate. In order to prevent adverse effects of cuff overinflation, it is better to recheck the pressure using a manometer, regardless of place, time and the inserter of the endotracheal tube.